Kids Feet

So, You Want a Child-Only Policy?

August 10, 2011

in Employee Benefits

Child-only policies are now available for purchase! For those unfamiliar, a child-only policy means there is no adult on the individual policy. This is great news for parents in many different situations, including those that simply cannot afford to put their child(ren) on the group health insurance plan.

Under the new health care reform law, insurance carriers in the individual (non-employer) market can no longer deny coverage to a child with a pre-existing condition. However, in the 2011 legislative session, the Colorado Legislature passed and signed into law that takes an additional step by requiring any insurance company that sells individual policies to adults and families, to also sell child-only policies.

Like many employer plans, there will now be “open enrollment” periods when child-only policies can be purchased. The open enrollment period began on August 1st, 2011 and ends on August 31st, 2011. Coverage will be effective on October 1st, 2011.

If you are interested in applying your child for a child-only policy, applications will need to be completed and returned to our office by the August 31st deadline. After this deadline passes, there will not be another open enrollment period until 2012, in which insurance carriers will then be required to hold an open enrollment period each January and July for the entire month.

Outside of open enrollment, the only other time you may apply for child-only coverage is if a parent experiences a qualifying event (ie birth, adoption, marriage, divorce, loss of employer-sponsored coverage, loss of eligibility for Medicaid or CHP+, entry of a valid court or administrative order mandating the child have coverage, or involuntary loss of existing coverage).

All child-only policies are guarantee-issue, meaning the insurance carrier cannot deny coverage unless the child has access to other creditable coverage such as a parent’s plan through an employer. Although these policies are guarantee-issue, an insurance carrier can still charge a higher premium if a child has a pre-existing condition.

Both CIGNA and Anthem are only offering (1) child-only policy each. Below is a side-by-side comparison of their benefits. Rocky Mountain Health Plans is another carrier that will also be offering child-only policies, but they have several policy options available. Please call our office if you would like more information on a Rocky Mountain Health Plan child-only policy or would like to see complete benefit summaries of the CIGNA or Anthem child-only plans.

CIGNA Open Access 5000/80% PPO Plan Anthem SmartSense Plus Standard Rx $2,000 Plan
What You’ll Pay for In-Network Benefits
Individual Family Individual Family
Annual Deductible $5,000 $10,000 $2,000 $4,000
Annual Out-of-Pocket Maximum $10,000 $20,000 $5,500 $11,000
Annual Lifetime Maximum Benefit No maximum benefit No maximum benefit
Primary/Specialist Care Doctor Visit $50 copay per visit $30 copay per visit
Preventive Care Screenings No cost; plan pays 100% No cost; plan pays 100%
Inpatient/Outpatient Hospital 20% after Deductible 30% after Deductible
Lab, X-ray, MRI/CT/PET Scans
Emergency Room 20% after $100 Deductible
Urgent Care 20% after Deductible
What You’ll Pay for Prescription Medication per Prescription
Brand Name Drug Deductible
(must be met before you pay a copay)
$500 None
Generic $10 copay $15 copay
Brand $35 copay $40 copay
Non-Preferred $60 copay $60 copay
Self-Injectable 30% 25%

If you are interested in applying for coverage, would like to obtain rate information or have any other questions, please call our office.

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